Major Abdominal Surgery Clinical Trial
Official title:
Immune-mediatory Response of Intravenous Ketamine Versus Propofol for Major Abdominal Surgeries: a Prospective Randomized Study
Host systemic responses to vigorous stimuli as trauma, surgical tissue injury, anesthesia and
post-operative pain, leads to release a variety of pro-inflammatory cytokines including
interleukin-1 (IL-1) and interleukin-6 (IL-6) mainly from monocytes and macrophages Thus, the
rise of IL-6 is regarded as an early marker of tissue damage and its rise proportional to the
degree of tissue damage .
It has been demonstrated that systemic responses to stress may be modified by the anesthetic
technique used . Total intravenous anesthesia (TIVA) especially propofol based greatly
suppresses the stress response induced by surgery when compared to inhalation by lowering
cortisol levels.
Ketamine has the ability to modulate (modify) inflammation . Even the sub-anesthetic doses of
ketamine in animal models were even provided to have an effect on the inflammatory response
system in the central nervous system
The release a variety of pro-inflammatory cytokines including tumor necrosis factor-α
(TNF-α), interleukin-1 (IL-1) and interleukin-6 (IL-6) mainly from monocytes and macrophages
due to surgical trauma or anesthesia .
IL-6 is constantly found in the peripheral blood and rapidly within few minutes unlike other
pro inflammatory mediators. Thus, the rise of IL-6 is regarded as an early marker of tissue
damage and IL-6 levels are proportional to the degree of tissue damage . The two major
actions of IL-6 are having a key role in regulating stress responses by activating the
hypothalamic-pituitary- adrenal (HPA) axis and synthesizing fibrinogen (which is necessary
for the acute-phase response) serving as a growth factor for activated B-cells .
While appropriate inflammatory reactions are advantageous and essential for wound healing and
host defense against microorganisms, excessive immune responses can be detrimental. The
released mediators prompt systemic endocrine, immunological and metabolic responses result in
increased pain sensitivity, altered metabolism, hyperthermia and greater secretion of liver
acute phase proteins and stress hormones, so yields unstable patient's hemodynamic status
Propofol was documented to have an advantage in terms of inflammatory and immunomodulatory
effects through significant effect on TNF-α, IL-6 and IL-10 release .
Ketamine has the ability to modulate (modify) inflammation and this is why it is recommended
in patients with sepsis undergoing surgery . This may be possibly related with the variations
in TNF-α and nuclear factor-κB expression . Even the sub-anesthetic doses of ketamine in
animal models were even provided to have an effect on the inflammatory response system in the
central nervous system which is involved in its therapeutic effect on depression (Yang-2 et
al., 2013).
This study will be conducted to compare between the intravenous infusion of ketamine against
the intravenous infusion of propofol during general anesthesia in patients undergoing major
abdominal surgeries.
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